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Don’t let it happen to you

by Sumiko Oshima

You might think that athlete’s foot is a man’s problem and the bunion, or hallux valgus, is a woman’s problem. You’d be wrong. There are many female patients who knowingly or unknowingly carry the fungal infection on their feet, while some male bunion patients live with a painfully deformed toe.

Athlete’s foot (mizumushi in Japanese) is perhaps the last thing many women would imagine suffering from. But a recent Japan Foot Week study by a group of physicians has revealed that women are far from immune from the condition. Among 12,500 Japanese patients who visited a dermatologist for various reasons in May last year, 40 percent were diagnosed as having athlete’s foot. Half of these sufferers were women.

Twenty percent of people (both men and women) who visited a doctor for other dermatological complaints, the study found, also had athlete’s foot — and were totally unaware of the condition.

“Many think that since their skin is not itchy, it cannot be athlete’s foot,” said Shotaro Harada, a dermatologist at Kanto Medical Center NTT East Corp. who headed the study. “Including such ‘hidden’ patients, there are an estimated 20 million to 30 million athlete’s foot patients in this country.”

What’s the problem

The condition, whose medical name is tinea pedis, is caused by a type of fungus that grows and multiplies on all humans. The infection does not occur among people who traditionally go barefoot. Moisture, sweating and a lack of proper ventilation of the feet all provide the perfect environment for the fungus to grow.

“Most industrialized countries are found to have an incidence rate similar to that of Japan,” Harada said.

Symptoms vary. In some, the skin between the toes peels, cracks and scales. In others, there is redness, scaling and even blisters on the soles and along the sides of the feet. These skin changes may be accompanied by itching and, when scratched, a burning sensation.

If left untreated, the fungus spreads over the soles and toenails. Itchiness is often not felt at this point, leading patients to believe — incorrectly — that they are cured.

The infection may also spread to other parts of the body such as the scalp, genitals and face.

“Last year I saw a beautiful young female patient who suffered from redness on her face. She said the condition did not get better with the cream she received from another clinic. At the first look, I knew it,” Harada said. “I asked her to show me her feet and, just as I’d thought, she had athlete’s foot.”

Since athlete’s foot is caused by a fungus, treatment is simple: the application of fungicidal chemicals.

Treat me right

Although dozens of over-the-counter antifungal creams and sprays are available at drug stores, they are less effective than prescribed medications, says Masataro Hiruma, a dermatologist and assistant professor at the Juntendo University School of Medicine in Tokyo. “In addition, if blisters and rashes are not caused by fungi, inappropriate treatment can worsen the condition,” Hiruma said.

The most important thing in treating athlete’s foot is continued application of the prescribed antifungal preparation. While the skin might look better, the infection can linger for some time afterward. Doctors say many people stop applying cream or taking drugs once the condition improves. This is the main cause of frequent recurrence, and it leads to the mistaken belief that athlete’s foot is incurable. It actually only takes several months to be completely cured.

Oral antifungal drugs — amajor breakthrough in the treatment of athlete’s foot in the 1990s — are also becoming more available. Such drugs have proved to be particularly effectiveagainst toenail infections, which can often be so stubborn as to be incurable by the direct application of cream.

“In the future, athlete’s foot might be treated by simply swallowing a pill,” Hiruma said.

Compared to unisex athlete’s foot, bunions are chiefly a problem for women; research has found that only 10 percent of patients visiting orthopedists for hallux valgus are men. The reason is clear: The number of women wearing narrow, high-heeled or pointed shoes is much greater than that of men.

“But it is useful to remember that men may also suffer. Male patients are most frequently found among those wearing standard-issue uniforms and shoes, such as policemen and fire fighters, and those who dance,” said Tadao Ishizuka, an orthopedist and the director of Jonan Hospital in Tokyo’s Meguro Ward.

Gradual dislocations

Tight shoes put enormous pressure on the front of the foot and squeeze toes together at unnatural angles. The continuous pressure eventually leads to dislocation of the joint at the base of the big toe; this is then forced in toward the rest of the toes, creating a bunion that can sometimes cause extreme pain.

“Different from dislocations of the joint in sports, the dislocation progresses gradually in hallux valgus and causes no pain at first,” Ishizuka said.

However, the degree of deformity is, oddly enough, not linked directly to the level of pain experienced by sufferers. Some people with a slight deformity feel severe pain, while others with painful-looking toes feel all right.

“It is surprising to see some people whose big toe is crossing over the second toe without pain,” Ishizuka said.

Exercise of toes, padding and taping bunions, anti-inflammatory drugs and changing shoes to ones with a wide and deep toe box may help reduce pain and prevent worsening of the deformity.

If discomfort prevents daily activities, surgery may be necessary. The procedure involves realigning the big toe joint and bone, and recovery takes several weeks.

In addition to toes, nails may also become deformed. A widespread problem, ingrown toenails mostly appear on the big toe. As with bunions, ingrown toenails may be caused by tight-fitting shoes. The malady also results from fungal infections and injuries.

But Eiichi Machida, an orthopedist at Takadanobaba Hospital in Tokyo, believes that incorrect toenail trimming is the most significant cause of the condition. “People often trim their toenails too much, and rounding off the corners is a particular problem,” he said.

The impairment is not only a cosmetic defect: Nails digging into the soft tissue of nail grooves can cause irritation, redness and even swelling accompanied by severe pain.

Inserting cotton between the nail and the toe may help the nail to grow out correctly in mild cases. As with bunions, though, doctors often recommend the patient undergoes surgery to remove the corner of ingrowing nails in cases of painful deformity.

Wired for sound nails

Machida has recently developed a unique and ingenious treatment for ingrown toenails — using an “elastic” wire. Because ingrown toenails typically form an “n” shape, like a pincer, Machida’s technique aims to straighten out the nail.

A special nickel-titanium wire is inserted through holes made in the nail, forming a loop. However, the wire is a “memory alloy,” which gradually returns to its “remembered” state — that of being straight. As the nail grows, the wire exerts continual outward pressure and slowly straightens it out.

It takes just five minutes to fit the wire, which is replaced every two months as the nail grows. The ingrown condition can be completely cured after one to 11/2 years.

So far, 1,000 people have been successfully treated, said Machida.

“The pain goes away in a week. The duration of the cure depends on the symptoms and the hardness of the nails — up to a few years when the nail is replaced with new tissue,” he said.

Machida’s wire treatment has been granted a patent in Japan, the United States and the European Union.

“With this treatment, in the future I expect that most patients will no longer need surgery,” Machida said.